In this episode, Kareem sits down with Dr. Val Arkoosh, Pennsylvania’s Secretary of Human Services, a physician, former Montgomery County Commissioner, and someone Kareem has served alongside on boards. She leads a team of about 16,000 people and a budget of roughly $60 billion that runs Medicaid, SNAP, child care assistance, disability services, and more. In her words, if you’re born and raised in Pennsylvania, her department probably touches your life somewhere between cradle and grave. Val grew up in Omaha, Nebraska, the granddaughter of Lebanese immigrants and the daughter of a first-generation college graduate who built his own business. After an illness at age five, she decided she wanted to be a doctor. She majored in economics at Northwestern almost by accident, which she now calls one of the best decisions she ever made. After medical school she came to Philadelphia for residency and stayed for 30 years, spending two decades as an obstetric anesthesiologist on labor and delivery floors. That’s where the pivot began. Too many of her patients needed things she couldn’t write a prescription for: food, housing, transportation. “If you have diabetes and you don’t have access to healthy food,” she says, “all the insulin in the world doesn’t make up for it.” Mid-career, she went back to school for a master’s in public health so she could work upstream, on the problems that put people in the hospital to begin with. Listeners will hear about: * Working on the policy and advocacy behind the Affordable Care Act, and why coalitions of nurses, clergy, parents, and police officers got Congressional staffers to really listen * Leading Montgomery County through COVID with near-daily briefings built on one rule: say plainly what you know, what you don’t know, and what you’re working to find out * Your Way Home, and why stable housing has to come first (“you can’t refrigerate your medication if you live under a bridge”) * Why she says “I don’t understand, explain that again” in every meeting, and why humble leaders make fewer mistakes * Her account of the past year at the department: SNAP benefits that stopped overnight during the federal budget impasse, grants canceled from one day to the next, and new Medicaid work requirements and six-month redeterminations for 750,000 Pennsylvanians * Modernization projects that sound boring and change everything: electronic health records in state hospitals for the first time, and finally leaving the mainframes behind * The coming “food as medicine” program, where a prescription for food becomes real, and her push to shift from a system of sick care to a system of health care * Her advice for anyone considering public service: figure out which problem you’re trying to solve, and whether government is where it can actually be solved This episode is for anyone who has seen a problem they couldn’t fix from where they stood and wondered where they’d need to go to fix it. Val Arkoosh’s career has been a series of answers to that question, and she’s still asking it. Listen to Pioneers of Possibility on Apple Podcasts: Listen on Spotify: Subscribe on YouTube: https://www.youtube.com/@pioneersofpossibilitypod #ValArkoosh #PublicService #PublicHealth #Pennsylvania #HumanServices #Medicaid #SNAP #FoodAsMedicine #HealthPolicy #AffordableCareAct #MontgomeryCounty #Leadership #DoctorsInGovernment #SocialDeterminantsOfHealth #HousingFirst #COVIDLeadership #WomenInLeadership #PreventiveCare #CareerPivot #PioneersOfPossibility This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit pioneerspod.substack.com